Minimal Change Disease with Progression to Focal Segmental Glomerulosclerosis: Support for an Immune-Mediated Disease Continuum.

Minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) are among the most common causes of primary nephrotic syndrome in adults. A 32-year-old female with diagnosed MCD, characterized by podocyte effacement and immunoglobulin G (IgG) dusting on initial biopsy, developed worsening renal function unresponsive to first-line treatment with corticosteroids. Persistence of symptoms led to repeat biopsy, which identified collapsing FSGS that was effectively treated with plasmapheresis (PLEX). This case explores the hypothesis that MCD and FSGS lie along a continuous spectrum of podocyte injury and emphasizes the need for early consideration of PLEX in the management of nephrotic syndrome associated with IgG dusting.